Comorbidities Significantly Affect Chronic Migraine Health Care Costs

A “whole person” approach to treating chronic migraine is likely more beneficial than treating only migraine.

Nearly 88% of people with chronic migraine (CM) have at least 1 comorbid condition that has an impact on health care costs associated with CM, according to the latest data reported in a white paper by Kenneth E. Thorpe, PhD, Robert W. Woodruff professor of health policy at Emory University in Atlanta, Georgia for the Headache and Migraine Policy Forum.1 While medical costs for treating CM were estimated at $5.4 billion in the United States in 2015, total costs associated with migraine and comorbid conditions exceeded $40 billion.

Using pooled data from surveys conducted by the Agency for health care Research and Quality (AHRQ) between 2008 and 2013, Dr Thorpe estimated that 4.2 million adults older than the age of 18 had CM during that time period, 94% of whom were insured privately or through Medicare or Medicaid (70%, 10%, and 8%, respectively.) The study identified hundreds of medications used to treat CM, with no single drug accounting for more than 3% of prescriptions. Substantial numbers of patients reported 1 or more comorbid chronic conditions, including mental disorders (37%), mood disorders (27%), and arthritis (28%), as well as heart-related problems such as hypertension (24%), hyperlipidemia (18%), and coronary heart disease (9%).

Spending for CM increased dramatically with the addition of comorbid conditions. While the costs for migraine alone were estimated at $800 per patient, migraine-specific costs nearly doubled to $1554 per patient with 4 or more comorbidities. Total health care spending for those 2 groups increased from $2056 for migraine alone to $17,197 for migraine with 4 or more comorbidities. Notably, this small sector of CM patients with 4 or more comorbidities accounted for the lion’s share of costs — $28 billion of a total $41 billion spent on CM.

The type of care also had an impact on total costs. The majority of patients (54%) received prescriptions only, spending an average of $683 in 2015, while spending for hospitalization associated with CM (utilized by less than 1% of patients) leapt to $15,616 per patient, accounting for 10% of total CM treatment costs.

One feature that significantly raised costs was physical disability associated with migraine and comorbid conditions, with increasing prevalence of disability as the number of comorbidities increased. While 20% of all patients with CM were disabled, the rate rose to 42% in patients with 4 or more comorbid conditions. Costs rose by 62% (from $1110 to $1796 per patient) in patients with CM who were disabled compared with patients who were not.

Dawn C. Buse, PhD, from the Albert Einstein College of Medicine of Yeshiva University, coinvestigator in the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study and American Migraine Prevalence and Prevention (AMPP) Study,2 emphasized the role that comorbidities may play in CM treatment. “In general, people with more comorbid conditions use greater health care resources including medical appointments, hospitalizations, medications, and even phone calls to providers,” she told Neurology Advisor. “Comorbidities are more common in chronic migraine. They make treatment more complicated and are associated with worse outcomes. I recommend that all providers screen for common comorbidities and treat or refer as appropriate.”

Dr Thorpe concluded that treatment of comorbid conditions is altered by the presence of CM, and that a “whole person” approach to providing CM care is “likely to provide substantial benefits.”